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Meng Y, Geng G, Ren Y, Zhang H, Gao Z, Liu Y, Shi J. Long-Term Outcome of Adrenocorticotropic Hormone Therapy in Children With New-Onset Infantile Spasms. Pediatr Neurol 2023; 143:100-105. [PMID: 37060643 DOI: 10.1016/j.pediatrneurol.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/30/2022] [Accepted: 02/18/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND To investigate for pretreatment clinical variables to predict the outcome of new-onset epileptic spasms after adrenocorticotropic hormone (ACTH) therapy and to identify risk factors for poor long-term outcome. METHODS We retrospectively studied 129 consecutive patients with infantile spasms syndrome (ISS). These patients received ACTH with antiseizure medication therapy for the first time and were regularly followed up for more than six months at our hospital. The response to treatment was assessed after two weeks of ACTH injection. Kaplan-Meier survival analysis and the multivariate Cox proportional hazard regression model were used. RESULTS Among the 129 patients, 61 (47.3%) had a good response after two weeks of ACTH treatment. At the time of the latest follow-up, 71 (55%) patients were seizure-free (International League Against Epilepsy class1). The univariate analysis revealed that normal neurodevelopment (P = 0.018), time lag of less than one month (P = 0.026), no hypsarrhythmia on EEG (P = 0.004), and serum calcium level ≥2.50 mmol/L (P = 0.035) were significantly associated with a good response. Only a good response to ACTH therapy was significantly associated with a positive long-term outcome. The Kaplan-Meier survival analysis showed that serum calcium level ≧2.50 mmol/L was significantly associated with a positive long-term outcome (P = 0.030). Multivariate analysis confirmed that no response to ACTH therapy was an independent variable that predicted long-term seizure recurrence (P < 0.001, hazard ratio = 4.602, confidence interval = 2.252 to 9.406). CONCLUSIONS A good response to ACTH therapy had a significant predictive value for long-term seizure outcomes. Calcium may play an important role in the treatment of ISS with ACTH.
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Affiliation(s)
- Yao Meng
- Department of Epilepsy Center, Children's Hospital Affiliated to Shandong University, Jinan Children's Hospital, Jinan, ShanDong, China; Department of Functional Neurosurgery, Children's Hospital Affiliated to Shandong University, Jinan Children's Hospital, Jinan, ShanDong, China
| | - Guifu Geng
- Department of Epilepsy Center, Children's Hospital Affiliated to Shandong University, Jinan Children's Hospital, Jinan, ShanDong, China; Department of Functional Neurosurgery, Children's Hospital Affiliated to Shandong University, Jinan Children's Hospital, Jinan, ShanDong, China
| | - Ying Ren
- Department of Epilepsy Center, Children's Hospital Affiliated to Shandong University, Jinan Children's Hospital, Jinan, ShanDong, China
| | - Hongwei Zhang
- Department of Epilepsy Center, Children's Hospital Affiliated to Shandong University, Jinan Children's Hospital, Jinan, ShanDong, China
| | - Zaifen Gao
- Department of Epilepsy Center, Children's Hospital Affiliated to Shandong University, Jinan Children's Hospital, Jinan, ShanDong, China
| | - Yong Liu
- Department of Epilepsy Center, Children's Hospital Affiliated to Shandong University, Jinan Children's Hospital, Jinan, ShanDong, China
| | - Jianguo Shi
- Department of Epilepsy Center, Children's Hospital Affiliated to Shandong University, Jinan Children's Hospital, Jinan, ShanDong, China; Department of Functional Neurosurgery, Children's Hospital Affiliated to Shandong University, Jinan Children's Hospital, Jinan, ShanDong, China.
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Huang YC, Chao YC, Lee IC. Syndromic and non-syndromic etiologies causing neonatal hypocalcemic seizures. Front Endocrinol (Lausanne) 2022; 13:998675. [PMID: 36440223 PMCID: PMC9685421 DOI: 10.3389/fendo.2022.998675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The diagnosis of neonatal hypocalcemic seizures (HS) in newborns is made based on clinical signs and serum calcium level. Their etiology is broad and diverse, and timely detection and initiation of treatment is essential. METHODS We retrospectively reviewed 1029 patients admitted to the neonatal intensive care unit. Neonatal HS were diagnosed in 16 patients, and we compared etiologies and clinical outcomes, including clinical seizures and neurodevelopment at least over 1 year old. RESULTS The etiologies can be broadly categorized into 5 syndromic and 11 non-syndromic neonatal HS. Syndromic neonatal HS included 3 Digeorge syndrome, 1 Kleefstra syndrome and 1 Alström syndrome. Non-syndromic neonatal HS included 8 vitamin D deficiency, 1 hypoparathyroidism, and 2 hypoxic-ischemic encephalopathy. Patients with syndromic neonatal HS were found to have worse clinical outcomes than those with nonsyndromic HS. In eight patients with vitamin D deficiency, neurodevelopment was normal. Five of five patients (100%) with syndromic HS used two or more antiseizure drugs. However, among patients with non-syndromic neonatal HS, only one of 11 (9.1%) used more than one drug (p = 0.001). CONCLUSION This finding highlighted that syndromic hypocalcemic seizures in newborns have worse neurodevelopmental outcomes and are more often difficult to manage, and would benefit from a genetic diagnostic approach.
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Affiliation(s)
- Yi-Chieh Huang
- Division of Pediatric Neurology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yin-Chi Chao
- Division of Pediatric Neurology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Inn-Chi Lee
- Division of Pediatric Neurology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Qiu J, Guo H, Li L, Xu Z, Xu Z, Jing X, Hu Y, Wen X, Chen F, Lu X. Valproic acid therapy decreases serum 25-hydroxyvitamin D level in female infants and toddlers with epilepsy- a pilot longitudinal study. J Biomed Res 2020; 35:61-67. [PMID: 33342771 PMCID: PMC7874269 DOI: 10.7555/jbr.34.20200057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
To evaluate if valproic acid (VPA) therapy is associated with vitamin D deficiency among infants and toddlers with epilepsy, a cross-sectional clinical study was conducted in 25 children with epilepsy taking VPA. Blood levels of calcium, phosphorus, alkaline phosphatase, and 25-hydroxy vitamin D [25(OH)D] and plasma VPA level were measured at 1- to 3-month intervals. At the initial and final measurements, vitamin D deficiency or insufficiency was recognized in 8 (32%) and 12 (42%), respectively. In girls, a decreasing trend in serum 25(OH)D levels (P<0.05) was observed. Polytherapy had a significant negative effect on the longitudinal change of 25(OH)D (P<0.05) in girls. In conclusion, our study indicates that a high proportion of girls after VPA therapy had hypovitaminosis D.
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Affiliation(s)
- Jinchun Qiu
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Hongli Guo
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Ling Li
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China.,School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| | - Zeyue Xu
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China.,School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| | - Zejun Xu
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Xia Jing
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Yahui Hu
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Xiaoyi Wen
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Feng Chen
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Xiaopeng Lu
- Department of Neurology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
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Hermsen A, Eienbröker A, Haag A, Mylius V, Hamer HM, Menzler K, Karakas E, Rosenow F. Perioperative changes in cortical excitability, mood, and quality of life in patients with primary hyperparathyroidism: a pilot study using transcranial magnetic stimulation. Eur J Endocrinol 2014; 170:201-9. [PMID: 24174287 DOI: 10.1530/eje-13-0552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Serum calcium (Ca(2)(+)) and parathyroid hormone (PTH), amongst others, modify cortical excitability. Alterations in cortical excitability were shown in patients with epilepsy as well as hyper- or hypoparathyroidism. In patients with primary hyperparathyroidism (pHPT), preoperative elevated serum calcium and parathyroidectomy (PTx) may affect mood and quality of life. We hypothesized that perioperative changes in Ca(2)(+) and PTH in pHPT will affect cortical excitability and improve subjective health. DESIGN AND METHODS Transcranial magnetic stimulation (TMS) was performed before and after surgery in 15 pHPT patients. We measured resting motor threshold, cortical silent period (CSP), short intracortical inhibition, and intracortical facilitation. Health questionnaires were administered before, 1 day and 6 months after PTx, along with the disease-specific Pasieka's parathyroid assessment of symptoms (PAS), which was, to our knowledge, its first use in German. RESULTS SURGERY WAS SUCCESSFUL IN ALL PATIENTS. TMS-MEASUREMENTS REMAINED UNCHANGED WHEN ANALYZING ALL PATIENTS IN THIS PILOT STUDY. POSTOPERATIVELY, DEPRESSION DECLINED (P=0.05) AND QUALITY OF LIFE IMPROVED SIGNIFICANTLY (P=0.001) IN THE SF-36-SUBSCALES: vitality, social functioning, mental health and subjective health transition (post-hoc analysis). The PAS proved early relief of disease-specific symptoms (P<0.001). CONCLUSIONS We found unchanged cortical excitability comparing pre- and post-PTx in this pilot study. Mood and quality of life improved postoperatively. The German PAS is valuable in detecting disease-specific changes early after PTx.
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Affiliation(s)
- A Hermsen
- Department of Neurology, Epilepsy Centre Hessen, Philipps-University Marburg, Baldingerstr., 35043 Marburg, Germany
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Zhou FW, Roper SN. TRPC3 mediates hyperexcitability and epileptiform activity in immature cortex and experimental cortical dysplasia. J Neurophysiol 2013; 111:1227-37. [PMID: 24353305 DOI: 10.1152/jn.00607.2013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Neuronal hyperexcitability plays an important role in epileptogenesis. Conditions of low extracellular calcium (Ca) or magnesium (Mg) can induce hyperexcitability and epileptiform activity with unclear mechanisms. Transient receptor potential canonical type 3 (TRPC3) channels play a pivotal role in neuronal excitability and are activated in low-Ca and/or low-Mg conditions to depolarize neurons. TRPC3 staining was highly enriched in immature, but very weak in mature, control cortex, whereas it was strong in dysplastic cortex at all ages. Depolarization and susceptibility to epileptiform activity increased with decreasing Ca and Mg. Combinations of low Ca and low Mg induced larger depolarization in pyramidal neurons and greater susceptibility to epileptiform activity in immature and dysplastic cortex than in mature and control cortex, respectively. Intracellular application of anti-TRPC3 antibody to block TRPC3 channels and bath application of the selective TRPC3 inhibitor Pyr3 greatly diminished depolarization in immature control and both immature and mature dysplastic cortex with strong TRPC3 expression. Epileptiform activity was initiated in low Ca and low Mg when synaptic activity was blocked, and Pyr3 completely suppressed this activity. In conclusion, TRPC3 primarily mediates low Ca- and low Mg-induced depolarization and epileptiform activity, and the enhanced expression of TRPC3 could make dysplastic and immature cortex more hyperexcitable and more susceptible to epileptiform activity.
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Affiliation(s)
- Fu-Wen Zhou
- Department of Neurosurgery and McKnight Brain Institute, University of Florida, Gainesville, Florida
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Modulation of nickel-induced bursting with 4-aminopyridine in leech retzius nerve cells. ARCH BIOL SCI 2010. [DOI: 10.2298/abs1004035p] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Paroxysmal depolarization shift has been identified as a characteristic
feature of the cellular basis of epilepsy. On Na+-dependent bursting, 1
mmol/l 4-aminopyridine (4-AP) produced a two-phase effect - a significant
depolarization accompanied by an increase in the frequency of bursting,
followed by repolarization along with a diminished frequency of bursting.
Neither 1 ?mol/l apamin nor 150 nmol/l charybdotoxin (ChTX) elicited any
significant effect on either bursting or standard conditions. Our results
suggest that 4-AP affects the bursting indirectly by altering the
excitability of the cell. The lack of effects of apamin and ChTX is probably
due to channel insensitivity to these blockers in leech.
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Thiel R, Fowkes SW. Down syndrome and thyroid dysfunction: Should nutritional support be the first-line treatment? Med Hypotheses 2007; 69:809-15. [PMID: 17382480 DOI: 10.1016/j.mehy.2007.01.068] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 01/27/2007] [Indexed: 10/23/2022]
Abstract
Individuals with Down syndrome (DS) not only have increased risk of hypothyroidism, they also tend to develop a relatively novel mild form of neonatal hypothyroidism. One problem that may predispose those with trisomy 21 to hypothyroidism is the overexpression of the gene DYRK1A, which may have an affect on the thyroid. While thyroxine supplementation (such as Synthroid) is increasingly being advised for those with DS, this treatment may have both positive and negative effects. Nutritional support for hypothyroidism offers some of the same benefits as drug therapy but without the likely negative long-term effects. Early 20th century practitioners used bovine glandulars for those with DS children, which were believed to help support thyroid function. Some doctors in more recent times have also included iodine, L-tyrosine, selenium, and zinc. As nutrition for those with DS has been safely used by some practitioners for many decades, it is suggested that nutritional thyroid support, and not necessarily thyroxine, should be considered for use as a first line treatment for those with trisomy 21. This paper also hypothesizes that nutritional interventions begun prenatally by the mother, may possibly also be of benefit.
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Affiliation(s)
- R Thiel
- Center for Natural Health Research, Down Syndrome-Epilepsy Foundation, 1248 E. Grand Avenue, Suite A, Arroyo Grande, CA 93420, USA.
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